title: The cervical end of an occipitocervical fusion: a biomechanical evaluation of 3 constructs. Laboratory investigation.
abstract: OBJECTIVE
  Stabilization with rigid screw/rod fixation is the treatment of choice for craniocervical disorders requiring operative stabilization. The authors compare the relative immediate stiffness for occipital plate fixation in concordance with transarticular screw fixation (TASF), C-1 lateral mass and C-2 pars screw (C1L-C2P), and C-1 lateral mass and C-2 laminar screw (C1L-C2L) constructs, with and without a cross-link.
  
  
  METHODS
  Ten intact human cadaveric spines (Oc-C4) were prepared and mounted in a 7-axis spine simulator. Each specimen was precycled and then tested in the intact state for flexion/extension, lateral bending, and axial rotation. Motion was tracked using the OptoTRAK 3D tracking system. The specimens were then destabilized and instrumented with an occipital plate and TASF. The spine was tested with and without the addition of a cross-link. The C1L-C2P and C1L-C2L constructs were similarly tested.
  
  
  RESULTS
  All constructs demonstrated a significant increase in stiffness after instrumentation. The C1L-C2P construct was equivalent to the TASF in all moments. The C1L-C2L was significantly weaker than the C1L-C2P construct in all moments and significantly weaker than the TASF in lateral bending. The addition of a cross-link made no difference in the stiffness of any construct.
  
  
  CONCLUSIONS
  All constructs provide significant immediate stability in the destabilized occipitocervical junction. Although the C1L-C2P construct performed best overall, the TASF was similar, and either one can be recommended. Decreased stiffness of the C1L-C2L construct might affect the success of clinical fusion. This construct should be reserved for cases in which anatomy precludes the use of the other two.
authors.affiliation: Department of Neurosurgery, University of Utah, Salt Lake City, Utah 84108, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Finn
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Fassett
authors.forename: Todd D
authors.initials: TD
authors.lastname: Mccall
authors.forename: Randy
authors.initials: R
authors.lastname: Clark
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Dailey
authors.forename: Darrel S
authors.initials: DS
authors.lastname: Brodke
mesh_terms: D001696:Biomechanical Phenomena; D001860:Bone Plates; D001863:Bone Screws; D002102:Cadaver; D002574:Cervical Vertebrae / Q000601:surgery*; D006801:Humans; D009777:Occipital Bone / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*